Department of Internal Medicine, Ali-Ebn e Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran.
Clinical Immunology Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
Int J Rheum Dis. 2020 Dec;23(12):1692-1697. doi: 10.1111/1756-185X.13975. Epub 2020 Sep 25.
Chronic inflammation and subsequent use of glucocorticoids can lead to relative adrenocortical insufficiency in patients with rheumatoid arthritis (RA). Previously, adrenocortical hormone, dehydroepiandrosterone (DHEA) was shown as a potential therapy for autoimmune disorders. However, data regarding effects of DHEA in RA are limited. The aim of this study was to investigate the effects of DHEA on quality of life (QOL) in premenopausal rheumatoid arthritis patients.
In this randomized double blinded, controlled trial 46 premenopausal rheumatoid arthritis patients were assigned to receive 50 mg/d DHEA (23 patients) or placebo (23 patients) for 12 weeks. Disease Activity Score of 28 joints - erythrocyte sedimentation rate (DAS28-ESR) questionnaire, visual analog score and swollen and tender joint counts (both 0-28) were used for assessment of disease activity. Persian-validated World Health Organization Quality of Life Brief version (WHOQOL BREF) questionnaire was used to assess quality of life.
In comparison to the control group more improvement in QOL (P = .025) and environment health (P = .001) was observed in the DHEA group. After adjustment for age and disease duration DHEA was associated with more improvement in QOL (P = .01), psychological (P = .02) and physical health (P = .03). A trend toward a decrease in ESR was observed in DHEA group (P = .06). DAS was improved in both groups; however, there was no significant change in DAS28 between groups (P = .88). Frequency of adverse events albeit minor was similar in both groups.
Our study supports a slightly superior effect of DHEA over placebo to improve QOL in premenopausal female patients with rheumatoid arthritis. We did not find improvement in DAS in the DHEA group over placebo.
慢性炎症及随后糖皮质激素的应用可导致类风湿关节炎（RA）患者出现相对肾上腺皮质功能不全。此前，肾上腺皮质激素脱氢表雄酮（DHEA）被认为是治疗自身免疫性疾病的一种潜在疗法。然而，关于 DHEA 在 RA 中的作用的数据有限。本研究旨在探讨 DHEA 对绝经前类风湿关节炎患者生活质量（QOL）的影响。
在这项随机双盲、对照试验中，46 例绝经前类风湿关节炎患者被分为 DHEA 组（23 例，每天 50mg）和安慰剂组（23 例），分别接受 12 周治疗。采用 28 关节疾病活动评分-红细胞沉降率（DAS28-ESR）问卷、视觉模拟评分和肿胀关节和压痛关节计数（均为 0-28）评估疾病活动度。采用经过波斯语验证的世界卫生组织生活质量简表（WHOQOL BREF）问卷评估生活质量。
与对照组相比，DHEA 组的生活质量（P=0.025）和环境健康（P=0.001）改善更为明显。在校正年龄和疾病持续时间后，DHEA 与生活质量（P=0.01）、心理（P=0.02）和身体健康（P=0.03）的改善有关。DHEA 组的 ESR 呈下降趋势（P=0.06）。两组 DAS 均有所改善，但两组间 DAS28 无显著变化（P=0.88）。两组不良反应发生率虽较低，但相似。
本研究支持 DHEA 略优于安慰剂，可改善绝经前女性类风湿关节炎患者的生活质量。我们没有发现 DHEA 组在 DAS 方面比安慰剂组有改善。
